The Intersection of Behavioral Health and the Justice System

“The large number of individuals with substance use disorders involved in the nation’s criminal justice system (CJS) represents a unique opportunity, as well as challenges, in addressing the dual concerns of public safety and public health,” wrote Belenko, Hiller, and Hamilton in a 2013 study on treating substance use disorder (SUD) in the criminal justice system. Unfortunately, only a small number of people who could benefit from treatment actually receive it while involved with the CJS. 

In a recent webinar for Harmony Foundation, Jessica Swan, MCJ, MAC, looked at how society responds to justice, mental illness, and substance use disorder. Swan is the executive director of Recovery Consulting. She has extensive experience in clinical addiction counseling, research, development, training, evaluation, and reporting for legal professionals, non-profits, governmental agencies, and communities nationwide. She writes addiction recovery curricula for treatment programs, offers counseling for individuals and families with SUDs, and provides addiction recovery consulting for organizations.

First off, Swan looked at how justice can be defined. As it turns out, it’s not that easy to define. Justice involves “concepts of fairness, equality, freedom, moral behavior, lawfulness, and order,” explained Swan. But we also have to consider the “specific context of time, culture, status, power, and demographic influences such as gender, race, ethnicity, age, and socioeconomics.”

Americans frequently think of justice as punishment, retribution, and correcting “bad” behavior, though. Overall, justice should not just be seen as a collection of laws but as the aspirational goal of justice for all with agreed-upon moral and ethical standards—a way of organizing society.

Swan then talked about justice and health—as “fairness in how people are treated and their ability to achieve the highest attainable standard of physical, mental, and social well-being. Justice is about the law but also about democracy, and it has the potential to be about health.”

Swan explained that five social domains determine health: healthcare access and quality, economic stability, social and community context, neighborhood and built environment, and last but not least, education access and quality.  

The determinants have a significant impact on the demographics of the justice system. The vast majority of the US prison population is male, with drug trafficking the most common crime by a wide margin. A significant share of the prison population is repeat offenders. 

In 2021, 67 percent of the federal prison population was either African-American or Hispanic. Only 30 percent were non-Hispanic white people, who make up 59 percent of the general population. African Americans or Hispanic people comprise only 13 and 19 percent of the US population, respectively.

Many of the prisoners were using drugs and alcohol when they committed their offenses, and many of them have a substance use disorder. Many people in the prison system also present with serious mental illness. However, “research shows that people with mental illness are not more violent than people without mental illness,” Swan said. 

As addiction professionals know well, there’s a strong correlation between substance misuse and mental health disorders. “Adults with co-occurring mental health and substance use disorders make up about two in 100 adults in the US but 15 in 100 adults arrested,” Swan told the webinar participants.

While many of them clearly need help, their mental health conditions actually have a very negative impact on their treatment by the justice system. “People with co-occurring mental health and substance use disorders are less likely to post bond, experience longer rates of incarceration, and are more likely to be placed in solitary confinement where symptoms dramatically get worse,” Swan said. 

While the focus often remains on punishment and retribution, decades of scientific research have shown that “providing comprehensive substance use treatment to criminal offenders while incarcerated works, reducing both drug use and crime after an inmate returns to the community.” Nevertheless, only seven percent of incarcerated people with co-occurring mental health and SUDs receive services for both problems. “Treatment during incarceration can reduce the risk of an overdose after release by 85 percent,” Swan reported. 

Without adequate treatment services, the risks after release from prison remain high. Such individuals are 62 percent more likely to die by suicide and 40 times more likely to overdose than the general population.  

In conclusion, Swan discussed possible solutions. “Incarcerating instead of treating is not a solution. That is justice solely as retribution when mental health and substance use disorders are the actual problems.”

Targeting the underlying issues includes known solutions such as better access to healthcare, improving community well-being, reducing early exposure to violence and accessibility to alcohol and drugs, and actively engaging in efforts to reduce racial inequality in the justice system. Other known solutions are enrolling people in Medicaid as they leave jail and prison, connecting people to services prior to leaving, and providing medications upon departure. 

Harmony Foundation is one of the longest-running and most successful addiction treatment centers in the world. If you or a loved one are struggling with alcohol or drug addiction, or you have questions about our programs, call us today at (866) 686-7867 to get the help needed as soon as possible. Our experienced staff is available 24 hours a day, seven days a week.